Provider Demographics
NPI:1336450584
Name:SUSSMAN, STEFANIE (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:STEFANIE
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E 63RD ST
Mailing Address - Street 2:APT 8G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7831
Mailing Address - Country:US
Mailing Address - Phone:917-597-4371
Mailing Address - Fax:212-759-4585
Practice Address - Street 1:405 E 63RD ST
Practice Address - Street 2:APT 8G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7831
Practice Address - Country:US
Practice Address - Phone:917-597-4371
Practice Address - Fax:212-759-4585
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014359-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist